BALD SCALP REDUCTION: A HISTORICAL PERSPECTIVE

Bald scalp reductions involve the removal of bald scalp from the crown and top of the head. In a single procedure, as much as 5 centimeters (almost 2 inches) in width can be removed, resulting in a rapid reduction in the size of the bald area. Scalp reductions do not treat hair loss in the front of the scalp, and follicular micrografting or follicular unit extraction can be performed simultaneously or subsequently to create a hairline, to further fill in the remaining areas of baldness, and sometimes right along the healed scalp reduction incisions.

Though once quite popular, scalp reductions are rarely performed anymore. Dr. Epstein and his partner continue to see patients who have had these procedures, and repair the scarring and hairline distortion that frequently are seen with these procedures.

Bald scalp within the dotted lines is excised, and the scalp edges are stitched in place.

Potential results after one or two scalp reductions. Further reductions may be done.

SCALP FLAP SURGERY

Like bald scalp reductions, scalp flap surgery is rarely performed today, due to the superiority of hair transplantation techniques. In scalp flap surgery, such as with the Fleming-Mayer flap and Juri flap, as many as 10,000 hairs are transplanted in a single procedure. The scalp flap is unique in its ability to create the densest hairline possible, in the shortest period of time. Unlike with hair grafting, the hair in a scalp flap begins to grow immediately. As with all other transplantation techniques, the hair continues to grow for a lifetime.

The downsides of scalp flap surgery include an abnormally dense, abrupt hairline, direction of hair growth posterior rather than the ideal anterior, scarring of the donor area along the side of the head, and the small but definite risk of failure of the flap.

First Stage: The flap is designed and cuts are made along the sides and the cuts are sewn.

Second Stage: After one week, a cut is made. The first and second stages are performed to reroute the blood supply so that the flap is nourished only by the blood vessels at its front.

Third Stage: Two weeks after the first stage, the flap is elevated and a hairline incision is made. The flap is rotated towards to front, and the donor area is closed.

Fourth Stage (completed): The flap is sewn in place. Note the bulge at the right side of the flap, which is corrected in four to six weeks. The blue line shows the position of a second flap, if used.

Dr. Epstein is one of a few select doctors trained in this demanding procedure, which requires extensive training and surgical experience. He no longer performs this procedure, because of the risk of scarring and unnatural appearance, and the superiority of follicular unit grafting.

Procedure: Grafts to Repair Hairline, 350 Grafts.Surgeon: Dr. EpsteinLocation: Miami, FLProcedure details: Before and after 350 grafts and scar repair to improve the aesthetic results from a prior performed scalp flap surgery

Before

After

Before

After

Procedure: Reparative.Surgeon: Dr. EpsteinLocation: Miami, FLProcedure details: Before and after repair of prior Fleming-Mayer Scalp Flap, achieved through additional grafting of 1,650 grafts. The abnormally dense abrupt hairline has been made to appear much more natural.